Squamous cell carcinoma (SCC) of the lids isn’t too common by the numbers (only about 0.09 to 2.42 cases per 100,000 people), but it’s the second most common eyelid malignancy worldwide. When treated early, the prognosis is good, but advanced tumor stages may require orbital exenteration or lead to mortality in systemic metastatic cases.

A recent study assessed eyelid SCC along with the corresponding clinical management and outcomes. The team compared findings to the classification system of the American Joint Committee on Cancer (AJCC). They noted that male sex, tumor location and lymph node diagnostics were predictors for eyelid SCC.

The retrospective analysis included data from 117 patients with histologically proven eyelid SCC at a tertiary center in Germany from January 2009 to March 2020. The data showed that 88 patients (75.2%) underwent histologically controlled excision and follow-up. The other patients, who were grouped into a higher T-category, received individual adjuvant therapy combinations.

The researchers noted significantly higher numbers of nodal metastasis and recurrence in male patients and those in a higher T-category. Additionally, patients with multiple lesions had significantly higher recurrence rates.

According to the analysis, disease-specific survival (DSS) was 95.7% at two years and 94.9% at five years. Six of the patients (5.1%) died from eyelid SCC; among these patients, nodal metastasis and higher T-category were negative prognostic factors.

The researchers reported that mortality was associated with tumor location (medial upper eyelid and lower eyelid alone) and nodal metastasis. They added that T-category differed in 34 patients (29.1%) when they introduced the AJCC 7 and 8 classifications. Specifically, the T-category changes in the AJCC 8 classification were better predictors of DSS.

“The predominance of recurrence in male patients noted may be associated with increased occupational sunlight exposure as suggested previously in an Australian publication including 51 cases of eyelid SCC,” the researchers wrote in their paper. “In the literature, a history of cutaneous SCC has been shown to have a three-times relative risk of developing another SCC compared with patients without SCC history, and recurrence has been described as an important prognostic factor in eyelid malignancies.”

“Special consideration should be paid to male patients, tumor location in the upper medial eyelid and lymph node diagnostics,” the researchers concluded. “Prediction of disease-specific survival proved superior as per the AJCC 8 staging system.”

Klingenstein A, Samel C, Messmer EM, et al. Epidemiological characteristics and clinical course of eyelid squamous cell carcinoma patients form a large tertiary centre between 2009 and 2020. Br J Ophthalmol. March 12, 2021. [Epub ahead of print].